Abstract：
BACKGROUND: Proximal femur simple bone cysts (SBCs) are rare in children, but with a risk of pathological fractures and the associated poor outcomes. This study aimed to evaluate the functional and radiographic outcomes of children with proximal femur SBCs.
METHODS: 38 children with proximal femur SBCs treated surgically at our department, West China hospital, were enrolled in the study. Patients were divided into two groups according to whether pathological fractures presented before treatment. The non-fracture group received treatment of open curettage, cavity electrocauterization, bone grafting, and fixation (proximal femoral plate, intramedullary nail or Kirschner wire). The pathological fracture group received the same procedures of curettage, electrocauterization, grafting, and fixation. Autogenous iliac bone grafting was done in all cases, and the artificial bone was used as a supplementary based on the size of the cavity. Postoperatively, all patients underwent hip spica or similar orthosis immobilization for six weeks and received the same rehabilitation program after the removal of hip spica. Patients were evaluated by two independent observers, including the functional results based on the Ratliff\'s criteria, avascular necrosis, healing rate based on the Neer scoring system, coxa vara, and premature physeal arrest. We described the good outcome in Ratliff\'s criteria as \"Satisfactory results\", and fair and poor outcomes as \"Unsatisfactory results.\" Grade 1 and grade 2 Neer results were termed as failures in treatment, and grades 3 and 4 were considered successes and healing.
RESULTS: 38 patients with 38 hips (18 on the left side and 20 on the right side) were evaluated, including 9 females and 29 males, with a mean age of 9.0±2.6 years old (range, 5 to 14 years). There was no significant difference between these two groups in the baseline data of gender, age, side, grafting, staging, and fixation methods. The rate of unsatisfactory functional results in the pathological fractures group was 56.3% (9/16), significantly higher than that in patients without fracture (22.7%, 5/22. p= 0.047). There was also a significant difference in avascular necrosis of the femoral head between the pathological fractures group (7/16) and the group without fracture (2/22, p=0.021). Thirty cases presented with healing, including 13 in the fractures group and 17 in the non-fracture group (p=1.000), and eight cases were graded as failures (2 cases of grade 1 and 6 cases of grade 2). There were also no significant differences between these two groups in premature physeal arrest (2 in fracture group and 1 in non-fracture group, P=0.562), and Coxa vara (3 in the fracture group and 0 in non-fracture group, P=0.066).
CONCLUSIONS: Pathological fracture significantly increases the risk of unsatisfactory functional results and avascular necrosis of the femoral head in patients with femoral neck SBCs. Prophylactic treatment and fixation of SBCs in weight bearing proximal femur region is better to manage without complications than managing with pathological fractures.
METHODS: 38 children with proximal femur SBCs treated surgically at our department, West China hospital, were enrolled in the study. Patients were divided into two groups according to whether pathological fractures presented before treatment. The non-fracture group received treatment of open curettage, cavity electrocauterization, bone grafting, and fixation (proximal femoral plate, intramedullary nail or Kirschner wire). The pathological fracture group received the same procedures of curettage, electrocauterization, grafting, and fixation. Autogenous iliac bone grafting was done in all cases, and the artificial bone was used as a supplementary based on the size of the cavity. Postoperatively, all patients underwent hip spica or similar orthosis immobilization for six weeks and received the same rehabilitation program after the removal of hip spica. Patients were evaluated by two independent observers, including the functional results based on the Ratliff\'s criteria, avascular necrosis, healing rate based on the Neer scoring system, coxa vara, and premature physeal arrest. We described the good outcome in Ratliff\'s criteria as \"Satisfactory results\", and fair and poor outcomes as \"Unsatisfactory results.\" Grade 1 and grade 2 Neer results were termed as failures in treatment, and grades 3 and 4 were considered successes and healing.
RESULTS: 38 patients with 38 hips (18 on the left side and 20 on the right side) were evaluated, including 9 females and 29 males, with a mean age of 9.0±2.6 years old (range, 5 to 14 years). There was no significant difference between these two groups in the baseline data of gender, age, side, grafting, staging, and fixation methods. The rate of unsatisfactory functional results in the pathological fractures group was 56.3% (9/16), significantly higher than that in patients without fracture (22.7%, 5/22. p= 0.047). There was also a significant difference in avascular necrosis of the femoral head between the pathological fractures group (7/16) and the group without fracture (2/22, p=0.021). Thirty cases presented with healing, including 13 in the fractures group and 17 in the non-fracture group (p=1.000), and eight cases were graded as failures (2 cases of grade 1 and 6 cases of grade 2). There were also no significant differences between these two groups in premature physeal arrest (2 in fracture group and 1 in non-fracture group, P=0.562), and Coxa vara (3 in the fracture group and 0 in non-fracture group, P=0.066).
CONCLUSIONS: Pathological fracture significantly increases the risk of unsatisfactory functional results and avascular necrosis of the femoral head in patients with femoral neck SBCs. Prophylactic treatment and fixation of SBCs in weight bearing proximal femur region is better to manage without complications than managing with pathological fractures.
摘要：
背景：股骨近端单纯性骨囊肿（SBC）在儿童中很少见，但有病理性骨折的风险和相关的不良结局。本研究旨在评估股骨近端SBC患儿的功能和影像学结果。
方法：在我们部门手术治疗的38例股骨近端SBC患儿，华西医院,参加了这项研究。根据治疗前是否出现病理性骨折分为两组。非骨折组接受开放刮宫术治疗,空腔电灼术,骨移植,和固定(股骨近端钢板，髓内钉或克氏针）。病理性骨折组接受相同的刮宫术，电灼烧,嫁接,和固定。所有病例均进行自体髂骨移植,并根据空腔的大小使用人造骨作为补充。术后,所有患者都接受了髋骨固定或类似的矫形器固定6周，并在去除髋骨后接受了相同的康复计划。由两名独立观察者对患者进行评估。包括基于Ratliff标准的功能结果，缺血性坏死,基于Neer评分系统的治愈率，Coxavara,和过早的physeen逮捕。我们在Ratliff的标准中将良好的结果描述为“令人满意的结果”，以及公平和糟糕的结果，“结果不令人满意。“1级和2级Neer结果被称为治疗失败，3年级和4年级被认为是成功和治愈。
结果：评估了38例臀部（左侧18例，右侧20例）的38例患者，包括9名女性和29名男性，平均年龄9.0±2.6岁(范围，5至14年）。这两组在性别的基线资料上没有显著差异,年龄,侧面,嫁接,分期,和固定方法。病理性骨折组功能结果不满意率为56.3%(9/16),明显高于无骨折患者（22.7%，5/22.p=0.047)。病理性骨折组(7/16)与无骨折组(2/22,p=0.021)股骨头缺血性坏死也有显著差异。30例出现愈合，其中骨折组13例,非骨折组17例(p=1.000),8例失败（1级2例，2级6例）。这两组在性早搏方面也没有显着差异（骨折组2例，非骨折组1例，P=0.562),和Coxavara（骨折组3例，非骨折组0例，P=0.066)。
结论：病理性骨折显著增加了股骨颈SBCs患者功能效果不佳和股骨头缺血性坏死的风险。股骨近端负重区SBC的预防性治疗和固定比治疗病理性骨折更好。
方法：在我们部门手术治疗的38例股骨近端SBC患儿，华西医院,参加了这项研究。根据治疗前是否出现病理性骨折分为两组。非骨折组接受开放刮宫术治疗,空腔电灼术,骨移植,和固定(股骨近端钢板，髓内钉或克氏针）。病理性骨折组接受相同的刮宫术，电灼烧,嫁接,和固定。所有病例均进行自体髂骨移植,并根据空腔的大小使用人造骨作为补充。术后,所有患者都接受了髋骨固定或类似的矫形器固定6周，并在去除髋骨后接受了相同的康复计划。由两名独立观察者对患者进行评估。包括基于Ratliff标准的功能结果，缺血性坏死,基于Neer评分系统的治愈率，Coxavara,和过早的physeen逮捕。我们在Ratliff的标准中将良好的结果描述为“令人满意的结果”，以及公平和糟糕的结果，“结果不令人满意。“1级和2级Neer结果被称为治疗失败，3年级和4年级被认为是成功和治愈。
结果：评估了38例臀部（左侧18例，右侧20例）的38例患者，包括9名女性和29名男性，平均年龄9.0±2.6岁(范围，5至14年）。这两组在性别的基线资料上没有显著差异,年龄,侧面,嫁接,分期,和固定方法。病理性骨折组功能结果不满意率为56.3%(9/16),明显高于无骨折患者（22.7%，5/22.p=0.047)。病理性骨折组(7/16)与无骨折组(2/22,p=0.021)股骨头缺血性坏死也有显著差异。30例出现愈合，其中骨折组13例,非骨折组17例(p=1.000),8例失败（1级2例，2级6例）。这两组在性早搏方面也没有显着差异（骨折组2例，非骨折组1例，P=0.562),和Coxavara（骨折组3例，非骨折组0例，P=0.066)。
结论：病理性骨折显著增加了股骨颈SBCs患者功能效果不佳和股骨头缺血性坏死的风险。股骨近端负重区SBC的预防性治疗和固定比治疗病理性骨折更好。
